Eliminating Childhood Lead Poisoning in New York State by 2010

III. Environmental Scan

Based on 2000 Census data, New York State (including New York City) has nearly 1.7 million children under the age of 6 years, including 476,000 one and two year olds. Projections for 2010 indicate that New York State will have 1.65 million children under age six including 471,000 one and two year olds.

Children living in poverty is another important factor related to childhood lead poisoning. Because poverty limits housing choices, available housing for low-income families is generally found in communities with the oldest housing and the most deferred maintenance. As a result, these children are more likely to live in older deteriorated housing with lead paint hazards. The Federal General Accounting Office has estimated that 85% of lead poisoned children are eligible for Medicaid. According to the 2000 Census NYS has 198,252 or 20.2 % of families with children less than five years of age living below the federal poverty level. This places NYS 3rd among states with the most families with young children living in poverty.

New York State is experiencing a population change driven by foreign immigration and high levels of domestic in- and out migration. In 2000, 23% of New York's population was foreign born, more than twice the proportion in the nation. Meanwhile, New York State has the largest number of foreign and domestic residents (1.7 million) leaving the state. Out-migrations are typically young, educated, working-age adults and financially secure retirees. The effect of these moves on state and local economies and specifically on the real estate industry may be significant.

The age of New York State's housing stock makes it at high risk for containing lead paint. In New York State, 43.1% of dwellings, over 3.3 million homes, were built prior to 1950. Over fifty percent of the housing stock among the thirty-six high incidence zip codes previously identified was built before 1950. New York State has the most pre-1950 housing units in the country, with over one million more than the next highest state, Pennsylvania. The percentage of pre-1950 housing in New York State dwarfs that of states with a higher total number of homes.

Table 3. Age of housing among states with most housing units, 2000

States

% pre-1950 Housing

% Built pre-1950 Renter Occupied Housing

California

18.1

22.5

Texas

10.8

9.7

New York

43.1

47.5

Florida

6

4.2

Pennsylvania

40.3

43.3

Sorted by the total number of housing units (not shown)
Source: 2000 U.S. Census Data (Includes NYC data)

In February of 2000 the President's Task Force on Environmental Health risks and Safety Risks for Children issued a report entitled: Eliminating Childhood Lead Poisoning: A Federal Strategy Targeting Lead Paint Hazards. The report presents a coordinated federal program to eliminate childhood lead poisoning in the United States, and strategies for elimination of lead paint hazards over the next ten years. The report focuses primarily on expanding efforts to correct lead paint hazards, especially in low-income housing, as a major source of lead exposure for children. The report outlines a ten-year plan that will create 2.3 million lead-safe homes for low-income families with children, thereby resulting in net benefits of $8.9 billion as estimated by the federal Department of Housing and Urban Development. The report and proposed strategies focus on two major goals:

By 2010 eliminate lead paint hazards in housing where children under six years of age live. This goal is to be achieved by federal grants and leveraged private funding to identify and eliminate lead paint hazards in order to produce an adequate supply of lead- safe housing for low-income families with children;

By 2010 elevated blood lead levels in children will be eliminated through: increased compliance with existing policies concerning blood lead screening; and increased coordination across federal, state and local agencies responsible for outreach, education, technical assistance and data collection related to lead screening and abatement.

New York State Department of Health:

Responsibility for programs and activities related to childhood lead poisoning is shared in the Department of Health between two major program areas: the Childhood Lead Poisoning Prevention Program, located in the Center for Community Health, and the Bureau of Community Environmental Health and Food Protection, located in the Center for Environmental Health.

Center for Community Health: Childhood Lead Poisoning Prevention Program

The New York State Department of Health's Childhood Lead Poisoning Prevention Program (CLPPP), in partnership with local health departments and the health care provider community, coordinates a wide range of efforts to prevent, detect, and treat children with elevated levels of lead. The partners work together to: (1) pursue universal screening of one and two year olds and targeted screening of children ages six months to six years assessed to be at high-risk for lead exposure; (2) educate the public and health professionals about prevention, early detection, and treatment; (3) provide case management or oversight of case management for children with elevated blood lead levels, including environmental assessment and requiring lead hazard control; (4) ensure that families of children with lead poisoning are given advice and technical assistance in locating sources of lead in the child's environment; (5) provide assistance to pediatric care providers about medical management of children with elevated blood lead level through the establishment of regional lead poisoning prevention resource centers, and (6) provide lead-safe interim housing in some communities for families of children being treated for an elevated blood lead level of 20ug/dL or greater while the lead hazards in their environments are addressed.

Since 1992, New York State law has required health care providers to screen all children for lead by blood lead levels at one and two years of age, and allows the state to collect all blood lead test results on children. This law, combined with existing state and CDC resources, enables the state program to conduct surveillance, evaluate screening performance, and identify locations and other characteristics of lead poisoning cases. Analysis indicates that 62% of children born between 1994 and 1999 received a blood screen by twenty-four months of age. An additional 30% of children were screened after age twenty-four months, for an overall screening rate of 92% by age six. In the year 2000, 76% percent of children enrolled in Medicaid Managed Care plans were screened for blood lead levels by twenty-four months of age.

The Department of Health is modernizing its data collection and tracking systems. The department is in the process of launching an updated Internet based "Leadtrac" data system for local and state health department staff. The revised system will provide an enhanced system for matching tests to existing clients, a centralized database to help improve tracking of affected children moving between health jurisdictions, and additional data fields to improve program information and planning.

Specific activities carried out either directly by the state CLPPP or through contractual partners include:

Data collection and analysis of all blood lead tests;

Monitoring of lab reporting of blood lead tests;

Case management of identified lead-poisoned children;

Provision of temporary lead-safe housing for those children who are lead poisoned and need safe housing while their regular residence is undergoing remediation;

Education of the public about lead hazards and methods to reduce exposure;

Professional education to providers including assessment of lead screening in targeted provider offices;

Provision of consultation for medical treatment of moderately to severely lead-poisoned children;

Center for Environmental Health
The environmental assessment and lead hazard control components of case management are under the direction of the New York State Department of Health's Center for Environmental Health (CEH). Under the direction of CEH, environmental work is conducted by environmental health personnel in thirty-six county health departments, the New York City Department of Health, and the Department's nine district offices (which cover 21 upstate counties that do not have their own environmental health services). Environmental management is provided for children with an elevated blood lead level of 20 mcg/dL or higher in order to identify and eliminate sources of lead exposure. By law, the property owner is required to correct hazardous lead conditions when a child under age six is identified as having an elevated blood lead level of 20 mcg/dL or higher.

Healthy Neighborhoods Program
The Center for Environmental Health currently supports eight local Healthy Neighborhood Programs, with a total of $1.2 million annually. The Healthy Neighborhoods Program (HNP) is designed to provide preventive environmental health services to targeted geographic areas with a high rate of documented unmet environmental health needs which often result in adverse health outcomes for residents. HNP performs door-to-door outreach and education in high-risk areas. The advantage of HNP is that each dwelling receives a visual assessment and education regarding lead and other hazards that is specific to the dwelling. Competitive awards are made to local health departments utilizing Federal Preventive Health and Health Services Block Grant Funds. The target areas are selected according to the level of environmental and socio-economic factors that are measured in the community, including: percent of housing built before 1960; lead-based paint hazards; incidence of fires and arson; homes without smoke detectors; and cockroach, rodent and garbage complaints. Four of the HNPs outside of NYC are located in county jurisdictions with high incidence zip codes for childhood lead poisoning.

Housing Initiatives:

The Division of Housing and Community Renewal (DHCR) is the state agency responsible for housing. The Department of Health has partnered with DHCR to build the capacity to implement regulations for federally -assisted housing (rental, mortgages and public housing). It is expected that regulations will impact 80,000 housing units in New York State, impacting $86 million in federal funds and a large number of children living in federally assisted housing.

Over the last nine years the NYS Department of Health has supported local government applications for federal HUD grants to make homes lead safe. During this period local governments have received over $46 million and have completed over 2,700 housing units . Future plans include :

Hold numerous training events on lead based paint for renovators and remodelers;

Work closely with the weatherization program to train lead based paint supervisors;

Introduce peer-to-peer technical assistance focus groups pertinent to the needs and concerns of housing coalitions; and

Produce and maintain a strategic plan to expand lead-based paint control and improve training opportunities within the state.

NYS has a property maintenance code that prohibits peeling and chipping paint. The code is enforced by local Code Enforcement Officers in municipalities. The provisions of this code apply to all existing structure and all existing premises, and constitute the minimum requirements and standards for premises. Minimum conditions specified in the code include that 1) all exterior peeling, flaking, and chipped paint shall be eliminated and surfaces repainted; and 2) all interior painting, chipping, flaking, or abraded paint shall be repaired, removed, or covered. While current enforcement is variable, the existing code offers a basis for lead hazard reduction that is not currently maximized in high-risk communities.

As part of the strategic planning process, recent peer-reviewed published literature pertaining to strategies for prevention of lead poisoning in young children in the U.S. was reviewed. Comprehensive lead prevention strategies may include activities related to tertiary, secondary, and primary prevention of lead poisoning.

Screening and Education

Screening for elevated lead levels in at-risk children is a critical component of prevention efforts, supporting early identification and management of exposed children, and as a safety net to identify sources of lead exposure to prevent subsequent lead poisoning of other children.1 However, screening and follow-up medical management alone are clearly insufficient to eliminate childhood lead poisoning. While chelation therapy has had dramatic effects on mortality historically associated with high levels of acute lead poisoning, recent studies including large scale randomized clinical trials have failed to demonstrate any benefit of chelation on children with moderately elevated BLL in range of 20-44 mcg/dL, as measured by either changes in blood lead concentration or cognitive and behavioral scores.1,3,23-25 Intensive home-based educational efforts have been demonstrated to have some positive effects on reducing lead levels of lead-poisoned children, but alone are far from sufficient.26,27 Similarly, residential lead hazard control activities in response to identification of exposed children can have measurable impact on reducing blood lead levels in the range of 20-30 mcg/dL or higher, but does not appear to benefit children with blood lead levels in lower ranges in most studies.3,28,32

Primary Prevention

There is increasing consensus among researchers, health care providers, and policymakers that primary prevention strategies must be strengthened to achieve elimination of childhood lead poisoning. Educational strategies related to exposure avoidance and improved nutrition have been demonstrated to contribute to primary prevention, but alone are not sufficient to prevent lead poisoning.29-31 Residential lead hazard control measures, ranging from improved cleaning techniques to interim containment measures to complete lead abatement, are regarded as the most critical components of primary prevention. Scientific studies evaluating the efficacy of specific lead hazard reduction techniques, including low-cost interim hazard controls, confirm that such strategies can successfully reduce lead exposure, but more rigorous and detailed studies are greatly needed to guide primary prevention efforts.29,32-36 Because of the substantial input costs required to remediate housing, policy changes and enforcement of regulations have been studied as a component of lead poisoning prevention strategies. Preliminary research demonstrates that communities with more rigorous lead remediation laws, and more stringent enforcement of those laws, can be both cost-effective and successful at breaking the cycle of lead exposure and reducing blood lead levels among at-risk children.37-40